Article

[Community-acquired Staphylococcus aureus bacteremia: 17 years of experience in Argentine children].

Servicio de Control Epidemiológico e Infectología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan.
Archivos argentinos de pediatría (Impact Factor: 0.32). 08/2010; 108(4):311-7. DOI: 10.1590/S0325-00752010000400004
Source: PubMed

ABSTRACT Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B).
To analyze clinical, epidemiological, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007).
Retrospective, observational and comparative study. All children older than 1 month of age and CASaB were included.
During the study period 647 SaB were diagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSaB, respectively. The median age of patients was 5.9 and 4.8 years, respectively (p= NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p <0.05), respectively. Skin infection and septic shock were similar in both periods (78% vs. 67% and 5% vs. 8%; p= NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p <0.05). Resistance rates to clindamycin and gentamicin were more high during the second period (10% vs. 2% and 20% vs. 3%, respectively) (p <0.05). Patients in the second period had longer antibiotic treatment (X 16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p <0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p <0.05). The mortality rate was higher in the first period (13% vs. 4%) (p= NS).
A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.

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METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. 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